WellMed, part of the Optum family of businesses, is seeking a RN Prior Authorization Nurse to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Remote Data Entry, No Experience, $40/hr, Part-Time
Virtual Assistant, $45/hr, Remote, No Experience, Night Job
Entry-Level Remote Data Entry, $50/hr, Evening Job
Customer Support, No Degree, $40/hr, Remote, Weekend Job
Remote Phone Job, $42/hr, Part-Time, College Student Friendly
Virtual Assistant, $40/hr, Remote, No Degree, Night Job
Part-Time Data Entry, $45/hr, Remote, College Student Friendly
Remote Moderator, No Degree, $50/hr, Evening, Weekend Job
Remote Customer Support, $42/hr, Night Job, No Experience
Live Chat Support, $40/hr, Remote, Entry Level, Part-Time
Virtual Assistant, Remote, $42/hr, Weekend, No Experience
Remote Data Entry, $45/hr, No Degree, Night Shift
Part-Time Customer Support, $40/hr, Remote, College Student
Remote Live Chat, $50/hr, Part-Time, Evening/Night Job
Entry Level Phone Job, $42/hr, Remote, No Degree Required
Weekend Data Entry, $45/hr, Remote, No Experience
Remote Virtual Assistant, $40/hr, Evening, Part-Time Job
Remote Moderator, $42/hr, Part-Time, Weekend, No Degree
Data Entry, $45/hr, Remote, Night Shift, College Student Job
Phone Support, Remote, $50/hr, No Experience, Part-Time
Virtual Assistant, No Experience, $42/hr, Remote, Weekend
Remote Customer Support, $45/hr, Part-Time, College Student
Data Entry, Remote, $40/hr, Night Shift, No Degree
Evening Virtual Assistant, Remote, $45/hr, No Experience
Weekend Customer Support, $42/hr, Remote, College Student
Remote Data Entry, $50/hr, No Experience, Evening/Night Job
Virtual Assistant, $42/hr, Remote, Weekend, Entry Level
Remote Phone Support, $45/hr, Evening, No Experience Required
Data Entry, No Experience, $50/hr, Remote, College Student
Remote Moderator, $40/hr, Weekend, No Degree, Part-Time
Live Chat Support, Remote, $42/hr, Night Shift, College Student
Phone Job, $50/hr, Remote, No Degree, Part-Time, Weekend
Data Entry, $45/hr, Remote, Evening, No Experience Required
Virtual Assistant, No Experience, $42/hr, Remote, Part-Time
Remote Customer Support, $50/hr, Night Shift, No Degree
Remote Data Entry, $40/hr, College Student Friendly, Part-Time
Live Chat Support, $42/hr, Weekend, Remote, No Degree
Virtual Assistant, Remote, $45/hr, Evening, No Experience
Remote Phone Job, $50/hr, College Student, Night Shift
Remote Moderator, $42/hr, Weekend, No Experience Required
Data Entry, No Degree, $45/hr, Part-Time, Remote Job
Customer Support, $50/hr, Remote, Evening/Night Job, No Degree
Virtual Assistant, $42/hr, Remote, Weekend, No Degree
Remote Live Chat, $45/hr, College Student, No Experience
Remote Data Entry, $40/hr, Part-Time, No Degree Required
Phone Support, $50/hr, Weekend, Remote, No Experience
Virtual Assistant, $42/hr, Evening, Remote, No Degree
Remote Customer Support, $45/hr, No Experience, Part-Time
Data Entry, $50/hr, Night Job, No Degree, Remote
Remote Moderator, $40/hr, College Student Friendly, Part-Time
Virtual Assistant, Remote, $42/hr, Weekend, No Experience
Remote Phone Job, $45/hr, Part-Time, No Degree Required
Customer Support, $50/hr, Night Job, Remote, No Experience
Data Entry, Remote, $42/hr, Evening Job, No Degree
Live Chat Support, $45/hr, Weekend, Remote, College Student
Virtual Assistant, Remote, $50/hr, Part-Time, Night Shift
Data Entry, $40/hr, No Experience, Remote, Weekend Job
Remote Phone Job, $45/hr, No Degree, College Student Friendly
Customer Support, $42/hr, Remote, Evening, No Experience
Virtual Assistant, $50/hr, Weekend, No Degree, Remote
Remote Data Entry, $40/hr, Part-Time, College Student Job
Phone Support, Remote, $42/hr, Evening/Night Shift
Virtual Assistant, No Degree, $45/hr, Remote, Part-Time
Live Chat Support, $50/hr, Remote, No Experience Required
Remote Moderator, $42/hr, College Student, Weekend Job
Data Entry, $45/hr, Remote, Night Job, No Degree
Virtual Assistant, $50/hr, Remote, Part-Time, Evening Job
Remote Customer Support, $42/hr, Weekend, No Experience
Phone Job, $45/hr, Remote, Night Shift, No Degree
Remote Live Chat, $50/hr, College Student, No Experience
Data Entry, $40/hr, Part-Time, Remote, Weekend Job
Virtual Assistant, $42/hr, Remote, No Experience, Evening
Remote Phone Support, $45/hr, Night Job, College Student
Remote Moderator, $50/hr, No Degree, Weekend, Part-Time
Virtual Assistant, $40/hr, Remote, Night Shift, No Experience
Customer Support, $42/hr, Remote, Part-Time, No Degree
Remote Data Entry, $45/hr, Weekend Job, College Student
Phone Support, Remote, $50/hr, No Experience, Night Shift
Virtual Assistant, $42/hr, Evening, Remote, College Student
Live Chat Support, $45/hr, Part-Time, Remote, No Degree
Data Entry, $50/hr, Remote, Evening Job, College Student
Virtual Assistant, $40/hr, Weekend, Remote, No Experience
Remote Phone Job, $42/hr, Night Shift, College Student Friendly
Remote Customer Support, $45/hr, No Degree, Evening Job
Virtual Assistant, $50/hr, Part-Time, Remote, Weekend Job
Data Entry, $40/hr, Evening Job, No Experience, Remote
Remote Live Chat, $42/hr, Weekend, No Degree, Part-Time
Virtual Assistant, $45/hr, No Experience, Remote, Night Job
Phone Job, $50/hr, Remote, Part-Time, College Student
Remote Data Entry, $42/hr, Evening/Night Job, No Experience
Remote Moderator, $45/hr, No Degree, Weekend Job, Part-Time
Live Chat Support, $50/hr, Remote, Night Shift, No Degree
Virtual Assistant, $40/hr, Weekend, College Student, Remote
Remote Phone Job, $42/hr, Part-Time, No Experience Required
Remote Data Entry, $45/hr, No Degree, Weekend, Night Job
Virtual Assistant, $50/hr, Evening, Remote, College Student
Customer Support, $42/hr, Weekend Job, Remote, No Degree
Phone Support, $45/hr, Remote, No Experience, Evening Job
Data Entry, $50/hr, Night Shift, No Degree, Remote Job
Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. This position is responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Utilization Management Nurse works under the direct supervision of an RN or MD. This position requires 9AM - 6PM - CST / Monday - Friday and requires a rotating Saturday schedule with an adjustment day off during the week. If you have a Compact license and from anywhere within the U.S., you will have the flexibility to work remotely* as you take on some tough challenges. Position Highlights & Primary Responsibilities: Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines Determines medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines / criteria Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services Answers Utilization Management directed telephone calls; managing them in a professional and competent manner Refers case to a review physician when the treatment request does not meet necessity per guidelines, or when guidelines are not available. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within CMS or URAC mandated turn around times Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all calls made and received in regard to case communication and all demographic and service group information. Sends appropriate system-generated letters to provider and member May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired utilization nurses Identify and refer all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department Conducts rate negotiation with non-network providers, utilizing appropriate reimbursement methodologies Documents rate negotiation accurately for proper claims adjudication Identify and refer potential cases to Disease Management and Case Management Performs all other related duties as assigned In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted Texas RN license or compact license 2+ years of experience in managed care OR 5+ years of nursing experience Proficient in PC Software computer skills Preferred Qualifications: Authorization experience Telephonic and/or telecommute experience Utilization Review/Management experience ICD-10, CPT coding knowledge experience InterQual or Milliman knowledge/experience Proven excellent communication skills both verbal and written skills Proven solid problem solving and analytical skills Proven ability to interact productively with individuals and with multidisciplinary teams with minimal guidance The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employme nt.